Web-Exclusive Q&A: Digestive Disorders

Women & Infants' Center for Women's Gastrointestinal Health offers a comprehensive, multidisciplinary focus on problems with the gastrointestinal system of women, in a setting staff by all female practitioners.

How common are Hepatitis B and C in women?
The prevalence of Hepatitis C among American women varies with age and race, although it is estimated that close to 1% of women of childbearing age have the virus. The prevalence of Hepatitis B varies even more based upon race and age, with the Asian population being particularly affected now. An estimated total of .66% of American women of childbearing age is Hepatitis B positive.

Can a woman with Hepatitis C have a baby?
Yes, women who are Hepatitis C positive can get pregnant and deliver healthy babies. Approximately 3% of their infants will acquire the infection. As part of prenatal care, it is very important that women tell their health care providers of possible risk factors for diseases like Hepatitis C to protect their babies. If a woman is identified as positive, the risk of passing the infection to the baby can be reduced by decreasing the length of labor after the membranes are broken and avoiding scalp monitors during delivery. Babies born to mothers who are Hepatitis C positive must be tested at three, 12 and 18 months of age. Therapy is available for children who are infected.

What is irritable bowel syndrome (IBS) and what are its symptoms?
The causes of IBS are not understood but it is believed faulty movement of the intestine causes an accumulation of gas and bacteria in the bowel, which causes irregular bowel movements, a sensation of bloating sensation, and cramping.

How is IBS the same and/or different from inflammatory bowel disease (IBD)? With IBS, the movement of the intestine is altered but the lining of the intestine is normal. With IBD, which includes Crohn's disease and ulcerative colitis, the lining of the intestine becomes inflamed and ulcerated, causing bleeding, infection, scarring with narrowing and even blockage of the intestine. The two diseases often manifest similarly at the beginning with cramps and diarrhea but if IBD is not treated, it can lead to serious complications and even colon cancer.

How is IBD treated?
There are many medications - including newer and more potent ones - available to help control IBD by working to decrease inflammation in the intestine. Many patients never require surgery.

Are IBS and IBD more common in women?
Crohn's disease and ulcerative colitis, which are the most common forms of IBD, probably occur with the same frequency in men and women, although some studies suggest that Crohn's may be slightly more frequent in women.

Are there any gastrointestinal disorders related to pregnancy?
Pregnancy exacerbates almost all gastrointestinal disorders, from gastro esophageal acid reflux to IBS and IBD. Gallstone formation is enhanced and hepatitis and liver disease may get worse during pregnancy. In addition, there are a few specific gastrointestinal diseases that occur only during pregnancy. Hyperemesis gravidarum, for example, is a very extreme form of morning sickness that can lead to serious complications for the mother, including kidney failure and neurological issues, and fetal loss. In addition, pregnancy can also lead to cholestasis, which blocks the flow of bile from the liver; preeclampsia; and acute fatty liver.

What are the symptoms of colorectal cancer?
Symptoms vary depending on the location of the cancer within the colon or rectum, though there may be no symptoms at all. The most common presenting symptom is rectal bleeding. Cancers arising from the left side of the colon generally cause bleeding, and in their late stages may cause constipation, abdominal pain and obstructive symptoms. On the other hand, right-sided colon cancer may produce vague abdominal aching or weakness, weight loss and anemia from chronic blood loss.

Can colorectal cancer be prevented? How?
Screenings can detect CRC when it can be treated. In the meantime, certain practices have been identified as protecting the body against CRC, including:

Diet high in fruits and vegetables, and low in red meat, animal fat and/or cholesterol.

Folic acid, vitamin B6 and calcium.

Regular physical activity and maintenance of normal body weight.

Smoking cessation.

Regular use of aspirin or nonsteroidal anti-inflammatory drugs.

Hormone replacement therapy in postmenopausal women, although these drugs are not routinely recommended for chemoprevention of colon cancer due to the associated long-term risks.

HMG-CoA reductase inhibitors (statins), although data is conflicting.

Who should be screened? How often?
Screenings can detect CRC when it can be treated. For individuals at normal risk, screening tests should begin at age 50. The preferred approach is a screening colonoscopy conducted every 10 years. In addition, consider the following recommendations for screening:

Physician experts with the American College of Gastroenterology issued new recommendations that CRC screening in African Americans begin at age 45.

Colonoscopic surveillance needs to be performed at more frequent intervals for individuals at high risk for colon cancer (for instance, those with a personal history of CRC or adenomatous polyps, family history of CRC, HNPCC, FAP or IBD).

An alternate strategy consists of annual stool test for blood and a flexible sigmoidoscopic exam every three to five years.

In order to provide answers to your most pressing health care questions, the clinicians at Women & Infants participate in an ongoing series of web-exclusive interviews.